Antibiotik Imipenem golongan carbapenem

Intravenous Susceptible infections Adult: Combined with cilastatin: (as anhydrous imipenem) 1-2 g daily in divided doses every 6-8 hr, given via IV infusion. Doses 250 or 500 mg are infused over 20-30 min, and doses of 750 mg or 1 g over 40-60 min. Max: 4 g/day or 50 mg/kg. Child: >40 kg: same as adult dose. Child >3 mth and <40 kg: 15-25 mg/kg every 6 hr by IV infusion. Doses up to 90 mg/kg may be given to older children with cystic fibrosis. Neonates and infants <3 mth: 4 wk-3 mth, 25 mg/kg every 6 hr; 1-4 wk, 25 mg/kg every 8 hr; up to 1 wk, 25 mg/kg every 12 hr. Max: >40 kg: 4 g/day or 50 mg/kg; <40 kg: 2 g/day. Renal impairment: Max doses based on CrCl.

CrCl (ml/min) Dosage Recommendation 31-70 500 mg every 6-8 hr. 21-30 500 mg every 8-12 hr. 6-20 250 mg or 3.5 mg/kg (whichever is lower) every 12 hr. 5 Only give if haemodialysis is started within 48 hr.
Intravenous Prophylaxis of surgical infections Adult: 1 g may be given on induction of anaesthesia, followed by 1 g 3 hr later, with additional doses of 500 mg at 8 and 16 hr after induction if necessary. Intramuscular Mild to moderate susceptible infections Adult: 500 or 750 mg every 12 hr. Intramuscular Uncomplicated gonorrhoea Adult: 500 mg as a single dose.

Contraindications Special Precautions

Hypersensitivity. Caution when used in patients with known hypersensitivity to other -lactams due to possibility of cross-sensitivity. CNS disorders such as epilepsy; renal, hepatic impairment; pregnancy, lactation. Skin rashes, urticaria, eosinophilia, fever, nausea, vomiting, diarrhoea, tooth or tongue discoloration, and altered taste. Erythema multiforme, exfoliative dermatitis. Pain and thrombophlebitis may occur at the inj site. Potentially Fatal: Severe anaphylactic reactions. Stevens-Johnson syndrome and toxic epidermal necrolysis. Increased risk of seizures when used with ganciclovir. Ciclosporin may increase neurotoxicity of ifosfamide; ifosfamide may also raise serum levels of ciclosporin. Serum levels may be increased by uricosuric agents. May reduce efficacy of valproic acid; monitor. Potentially Fatal: Increased risk of seizures when used with ganciclovir. Ciclosporin may increase neurotoxicity of ifosfamide; ifosfamide may also raise serum levels of ciclosporin. Serum levels may be increased by uricosuric agents. May reduce efficacy of valproic acid; monitor. Click to view more imipenem Drug Interactions

Adverse Drug Reactions

Drug Interactions

Pregnancy Category (US FDA) Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if

the potential benefit justifies the potential risk to the foetus. Storage Intramuscular: Dry powder: Store below 25C. When reconstituted, satisfactory potency is maintained for 4 hr at room temperature and for 24 hr under refrigeration (5C). Solutions should not to be frozen. Intravenous: Dry powder: Store below 25C. When reconstituted, satisfactory potency is maintained for 4 hr at room temperature and for 24 hr under refrigeration (5C). Solutions should not to be frozen. Imipenem is bactericidal and acts by inhibiting bacterial cell wall synthesis. It has a very broad spectrum of activity in vitro, including activity against Gram-positive and Gram-negative aerobic and anaerobic organisms, and is stable to hydrolysis by lactamases. Distribution: Widely distributed in body tissues and fluids. Metabolism: Partially hydrolised in the kidneys. Excretion: In the urine via glomerular filtration and tubular secretion. Other Beta-Lactams

Mechanism of Action

MIMS Class

Sumber: MIMS.com

CARBAPENEMS
CARBAPENEMS are a class of beta-lactum, broad spectrum antibiotics which act by inhibiting the cell wall
synthesis and are known to be most effective against gram negative infections. Carbapenems, often in combination with other agents, remain a mainstay of therapy in patients with serious hospital-acquired infection. Carbapenems can be grouped as (2),

Group 1 includes broad-spectrum Carbapenems, with limited activity against non-fermentative Gram-negative
bacilli, particularly suitable for community acquired infections (e.g. ertapenem).

Group 2 includes broad-spectrum Carbapenems, with activity against non-fermentative Gram-negative bacilli
that are particularly suitable for nosocomial infections (e.g. imipenem and meropenem).

Group 3 includes Carbapenems with clinical activity methicillin-resistant Staphylococcus aureus Amongst these the most widely used Carbapenems include: Meropenum Imipenum +Cilastin Mechanism of Action: inhibition of cell wall synthesis Clinical Indications: Meropenem: Drug of Choice for the treatment for respirator-associated and/or aspiration nosocomial pneumonia in the ICU (3). Meropenem is known to be highly potent against Enterobacteriacae, Pseudomonas spp, Acinetobacter spp, H. influenza and anaerobic bacteria, with a fairly good potency against gram positive cocci. Meropenems is known to be active against resistant organisms this has stimulated its use for treatment of serious hospital acquired infections.(2) Meropenem is uased in the treatment of intra-abdominal infections (complicated appendicitis and peritonitis); treatment of bacterial meningitis in pediatric patients caused by S. pneumoniae, H. influenzae, and N. meningitides and in the treatment of complicated skin and skin structure infections caused by susceptible organisms. (3) Imipenem/ Cilastin:Imipenem and cilastatin sodium is a fixed combination of imipenem monohydrate (a semisynthetic carbapenem -lactam antibiotic) and cilastatin sodium. Cilastin is used in combination with IMipenem as it prevents renal metabolism of imipenem by dehydropeptidase I (DHP I). (2) Imipenem and cilastatin sodium solution is used as IV in the treatment of serious infections caused by susceptible organisms including lower respiratory tract, skin and skin structure, intra-abdominal, gynecologic, or bone and joint infections. The drug also is used as IV in the treatment of serious complicated or uncomplicated urinary tract infections, septicemia, or endocarditis caused by susceptible organisms. (2) Imipenem/Cilastatin and meropenem (group 2)(2)

Appropriate use
Empiric treament of severe nosocomial infections in critically ill patients or in ICU Failure of first-line antibiotics for Gram-negative bacterial (GNB) infections

Inappropriate use
Routine treatment of otitis media Routine treatment of acute exacerbations of chronic bronchitis

Directed treatment according to results of culture and susceptibility testing Chronic multiresistant pseudomonal infections In certain settings of neutropenic sepsis, severe nosocomial intraabdominal sepsis and meningitis

Surgical prophylaxis Routine treatment of communityacquired pneumonia (CAP) Routine treatment of communityacquired gynaecological infections Routine treatment of communityacquired urological infections Nosocomial or communityacquired Gram-positive sepsis

Meropenem for Injection (500mg and 1g) Imipenem & Cilastatin Sodium for Injection (500mg + 500mg)

Jenis Antibiotik Meskipun ada lebih dari 100 macam antibiotik, namun umumnya mereka berasal dari beberapa jenis antibiotik saja, sehingga mudah untuk dikelompokkan. Ada banyak cara untuk menggolongkan antibiotik, salah satunya berdasarkan struktur kimianya. Berdasarkan struktur kimianya, antibiotik dikelompokkan sebagai berikut: b. Golongan Beta-Laktam Diantaranya golongan karbapenem (ertapenem, imipenem, meropenem), golongan sefalosporin (sefaleksin, sefazolin, sefuroksim, sefadroksil, seftazidim), golongan betalaktam monosiklik, dan golongan penisilin (penisilin, amoksisilin)

Berdasarkan mekanisme aksinya, yaitu mekanisme bagaimana antibiotik secara selektif meracuni sel bakteri, antibiotik dikelompokkan sebagai berikut: 1. Mengganggu sintesa dinding sel, seperti penisilin, sefalosporin, imipenem, vankomisin, basitrasin. 2. Mengganggu sintesa protein bakteri, seperti klindamisin, linkomisin, kloramfenikol, makrolida, tetrasiklin, gentamisin. 3. Menghambat sintesa folat, seperti sulfonamida dan trimetoprim. 4. Mengganggu sintesa DNA, seperti metronidasol, kinolon, novobiosin. 5. Mengganggu sintesa RNA, seperti rifampisin. 6. Mengganggu fungsi membran sel, seperti polimiksin B, gramisidin.

1. Golongan Betalaktam : Yang termasuk dalam kelompok ini adalah : Penicilin Sefalosporin Monobaktam Karbapenem Imipenem Cara Kerja : Antibiotika dari golongan ini bekerja pada dinding sel kuman . Salah satu sifat penting dari golongan betalaktam adalah adanya kemungkinan kepekaan terhadap enzim betalaktamase yang diproduksi oleh kuman-kuman tertentu. Enzim betalaktamase dapat merusak cincin betalaktam pada antibiotik tersebut. Kepekaan terhadap enzim betalaktamase ini berbeda antara jenisjenis antibiotika. Antibiotik jenis betalaktam tertentu juga dapat menghambat kuman yang memproduksi betalaktamase ( Imipenem, Karbepenem, Meropenem)